As the detection rate of pancreatic cystic neoplasms (PCN) increases,recommendations or guidelines for the diagnosis and treatment of PCN have been released from professional organizations.From the perspective of radiology,we compared seven guidelines in terms of general introduction,preoperative monitoring methods and strategies,stratification of risk factors,surgical indications,and postoperative follow-ups,aiming to provide references for the evaluation of images and the formulation of individualized approach for the treatment of PCN.
Humans ; Pancreatic Cyst/therapy* ; Pancreatic Neoplasms/therapy* ; Pregnenolone Carbonitrile ; Radiography ; Radiology

PURPOSE: According to surgical dogma, patients who are recovering from general anesthesia after abdominal surgery should begin with a clear liquid diet, progress to a full liquid diet and then to a soft diet before taking regular meals. We propose patient-controlled nutrition (PCN), which is a novel concept in postoperative nutrition after abdominal surgery. METHODS: A retrospective pilot study was conducted to evaluate the feasibility and effects of PCN. This study was carried out with a total of 179 consecutive patients who underwent a laparoscopic appendectomy between August 2014 and July 2016. In the PCN group, diet was advanced depending on the choice of the patients themselves; in the traditional group, diet was progressively advanced to a full liquid or soft diet and then a regular diet as tolerated. The primary endpoints were time to tolerance of regular diet and postoperative hospital stay. RESULTS: Time to tolerance of a regular diet (P < 0.001) and postoperative hospital stay (P < 0.001) showed statistically significant differences between the groups. Multivariate analysis using linear regression showed that the traditional nutrition pattern was the only factor associated with postoperative hospital stay (P < 0.001). Multivariate analysis using logistic regression showed that traditional nutrition was the only risk factor associated with prolonged postoperative hospital stay (≥3 days). CONCLUSION: After abdominal surgery, PCN may be a feasible and effective concept in postoperative nutrition. In our Early Recovery after Surgery program, our PCN concept may reduce the time to tolerance of a regular diet and shorten the postoperative hospital stay.
Anesthesia, General ; Appendectomy ; Diet ; Humans ; Length of Stay ; Linear Models ; Logistic Models ; Meals ; Multivariate Analysis ; Nutritional Support ; Pilot Projects ; Postoperative Care ; Pregnenolone Carbonitrile ; Retrospective Studies ; Risk Factors

PURPOSE: The aim of this study was to determine early predictive value of acute pyelonephritis and urosepsis in patients with urolithiasis in the emergency department. METHODS: We retrospectively reviewed medical records of patients who visited the emergency department and were diagnosed with urolithiasis by computed tomography for three years. Patients with urolithiasis were grouped according to the presence of computed tomography (CT) findings with acute pyelonephritis. In baseline characteristics, laboratory and CT findings of the two groups were compared. Group 1 was defined as urolithiasis without acute pyelonephritis and group 2 was defined as urolithiasis with acute pyelonephritis. In addition, we compared the sepsis versus non-sepsis and percutaneous nephrostomy (PCN) versus non-PCN group in Group 2 for analysis of the hs-CRP level of each group. RESULTS: The total number of urolithiasis patients was 744. Among the patients, 84 (11.3%) had urolithiasis with acute pyelonephritis in CT findings. Age, sex, history of diabetes, history of urolithiasis, size of stone, duration of symptom, body temperature, blood pressure, heart rate, respiratory rate, leukocyte count, existence of pyuria, and hs-CRP differed significantly between the two groups, respectively. In multivariate logistic regression analysis, age, history of urolithiasis, existence of pyuria, and hs-CRP were shown to be independent predictors affecting acute pyelonephritis in patients with urolithiasis. The area under the receiving operator characteristics (ROC) curve for CRP was 0.820 (95% CI, 0.754-0.886) and leukocyte count was 0.631 [95% confidence interval (CI), 0.542-0.721]. Sepsis and PCN groups showed significantly higher hs-CRP level than non-sepsis and non-PCN groups. CONCLUSION: There were some independent predictive values of urolithiasis with acute pyelonephritis. It can be useful in early detection of acute pyelonephritis or sepsis, and it can be helpful in making treatment plans for patients of urolithiasis.
Blood Pressure ; Body Temperature ; C-Reactive Protein ; Emergency Service, Hospital ; Heart Rate ; Humans ; Leukocyte Count ; Logistic Models ; Medical Records ; Nephrostomy, Percutaneous ; Pregnenolone Carbonitrile ; Pyelonephritis* ; Pyuria ; Respiratory Rate ; Retrospective Studies ; Sepsis ; Staphylococcal Protein A* ; Urolithiasis*

We evaluated the effect of the pregnane X receptor agonist, pregnenolone 16 alpha-carbonitrile (PCN) on the expression levels of plasma monoamine transporter (PMAT) in the intestine. Male C57/BL6 mice were divided into two 2 groups: mice in the PCN group (n=3) were administered PCN once a day for 4 days, while those in the control group (n=3) received the same volume of vehicle once a day for 4 days. After the mice were killed 24 h after administration of the last dose of PCN or vehicle, and the expression levels of PMAT in the intestine tissues were isolated and measured the expression level of PMAT using immunohistochemical and western blotting analyses. The expression level of PMAT expression levels in the small intestine increased after PCN treatment. These results suggest that the induction of PMAT may play a clinically significant role by increasing intestinal absorption of PMAT substrates such as metformin.
Animals ; Blotting, Western ; Cell Membrane* ; Humans ; Intestinal Absorption ; Intestine, Small ; Intestines ; Male ; Metformin ; Mice ; Plasma ; Pregnenolone Carbonitrile

Recent years, various percutaneous procedures including cervical nucleoplasty have been developed for disc decompressions to relieve radicular pains caused by disc herniations. We report the application of percutaneous cervical nucleoplasty (PCN) by using the navigable disc decompression device in two patients of cervical herniated intervertebral discs (HIVD). A 38-year-old female diagnosed with C4-C5 disc extrusion with bilateral C5 roots impingement received nucleoplasty twice at C4-C5 disc level. After second procedure, her pain was improved from 6-7/10 to 1-2/10 by visual analog scale (VAS). The second case, a 51-year-male was diagnosed with C6-C7 disc extrusion with right C7 roots impingement and received the procedure at C6-C7 disc level. The pain improved from 8/10 to 3-4/10 by VAS. Successfully, we decompressed cervical herniated discs in 2 HIVD patients without major complications. The PCN with the navigable device will be recommended as an alternative treatment method for cervical HIVD.
Adult ; Decompression* ; Female ; Humans ; Intervertebral Disc Displacement ; Intervertebral Disc* ; Neck Pain ; Pregnenolone Carbonitrile

PURPOSE: Preoperative percutaneous nephrostomy (PCN) can be applied to urinary stone patients with pyelonephritis as well as obstructive uropathy; thus, some patients undergo flexible ureteroscopy (fURS) in the presence of a PCN tube. We evaluated the effectiveness of PCN during fURS for the management of renal stones. MATERIALS AND METHODS: We retrospectively analyzed 130 consecutive patients who underwent fURS for renal stones between January 2009 and December 2011. All fURS procedures were performed by a single experienced surgeon. The patients were divided into two groups depending on the presence of PCN during the surgery: patients with PCN (group 1, n=41) and patients without PCN (group 2, n=89). To evaluate operative outcomes, we compared success rates, operative times, and complication rates. We defined success as the absence of any residual stones in the kidney or stone fragments less than 2 mm that were too small to be extracted during follow-up. RESULTS: There were no significant differences in age, sex, body mass index, stone laterality, burden, or location between the two groups. The mean operative times of groups 1 and 2 were 50.1 and 58.3 minutes, respectively (p=0.102). The success rates of groups 1 and 2 were 95.1% and 82.0%, respectively (p=0.044). There was no statistically significant difference in the complication rate between groups 1 and 2 (p=0.888). CONCLUSIONS: Flexible ureteroscopy in the presence of PCN produced a superior outcome in terms of the success rate without increasing the operative time or complication rate. PCN may be helpful to induce better outcomes of fURS.
Body Mass Index ; Humans ; Kidney ; Kidney Calculi ; Nephrostomy, Percutaneous ; Operative Time ; Pregnenolone Carbonitrile ; Pyelonephritis ; Retrospective Studies ; Ureteroscopy ; Urinary Calculi

PURPOSE: To review our experience with the management of fragmented and retained pigtail percutaneous nephrostomy (PCN) tubes and to explore the reasons for the fragmentation. MATERIALS AND METHODS: We retrospectively reviewed our institute database from January 2006 to December 2011 for patients who had undergone retrieval of fragmented PCN tubes. We assessed the preoperative factors, operative technique, and post-operative outcomes. RESULTS: A total of seven patients (4 males and 3 females) had been diagnosed with fragmented PCN tubes. The mean age of the patients was 41.5 years. Of the seven patients, five required antegrade instrumentation by way of a percutaneous tract to remove the foreign body, mostly along with stone retrieval. One patient underwent ureterorenoscopy and pneumolithotripsy for a ureteric stone along with ureteroscopic removal of the PCN fragment. Another patient underwent nephrectomy of the kidney containing the PCN fragment because it had become nonfunctioning. All patients were free of stones and symptoms on follow-up. CONCLUSIONS: A prolonged waiting period for definitive surgery, urinary infection, and associated stone disease are significant factors causing fragmentation of PCN tubes. Proper insertion techniques, regular timed changes of the PCN tube, appropriate care of the PCN tube, and early surgery for underlying stone disease are required to avoid this complication. Patients with retained PCN tubes can be managed effectively with antegrade or retrograde endoscopic techniques while definitive management of the primary pathology is carried out, without any additional morbidity.
Foreign Bodies ; Humans ; Kidney ; Kidney Calculi ; Male ; Nephrectomy ; Nephrostomy, Percutaneous ; Polyurethanes ; Pregnenolone Carbonitrile ; Pyonephrosis ; Retrospective Studies ; Ureter

This study is to investigate the transportation of scutellarin in cell and live models and study on mechanism of absorption and transport of scutellarin in mouse liver. The concentration of scutellarin in plasma and liver from control and pretreated groups was determined by high performance liquid chromatography. The uptake of scutellarin was examined in control hepatocytes group, induced hepatocytes group and induced hepatocytes plus pravastatin group. Pravastatin can affect the pharmacokinetics of scutellarin in mouse: CL is decreased while AUC is increased. The scutellarin absorption of hepatocyte induced group was higher than that of control group, but was decreased in the group with pravastatin added. The research showed that there was potential drug interaction between pravastatin and scutellarin. The drugs may compete for oatp2 mediated transport pathway consisted in the uptake of scutellarin in liver.
Absorption ; Animals ; Apigenin ; blood ; metabolism ; pharmacokinetics ; Area Under Curve ; Biological Transport ; Cell Survival ; Chromatography, High Pressure Liquid ; methods ; Drug Interactions ; Glucuronates ; blood ; metabolism ; pharmacokinetics ; Hepatocytes ; cytology ; metabolism ; Liver ; metabolism ; Male ; Mice ; Organic Cation Transport Proteins ; metabolism ; Pravastatin ; metabolism ; pharmacology ; Pregnenolone Carbonitrile ; pharmacology ; Random Allocation

PURPOSE: We assessed the success rate of internal ureteral stenting and the complications for patients with ureteral obstruction secondary to non-genitourinary malignancy. MATERIALS AND METHODS: Between January 2001 and December 2005, ureteral stenting were attempted in 62 patients with ureteral obstruction secondary to non-genitourinary malignancy. Their medical records were reviewed for the primary diagnosis, the symptoms, the degree of hydronephrosis, the location of obstruction, stent failure, the time period until stent replacement due to stent failure, the complications and the status at the last followup. RESULTS: A total 62 patients underwent an attempt at retrograde ureteral stenting for malignant extrinsic obstruction. The mean patient age was 57.6 years(range: 32-84) and the mean follow-up was 12.6 months. 44 patients(71%) were women, and the most common cancer diagnoses were cervical cancer(19), rectal cancer(16) and stomach cancer(11). A total of 23 patients(37%) required immediate percutaneous nephrostomy(PCN) referral. A total of 14 patients experienced late failure and required PCN. A total of 39 patients underwent stent replacement at a mean interval of 3.5 months. CONCLUSIONS: At almost 1 year follow-up, stent failure due to extrinsic compression occurred in 55.7% of the patients(37 of 62). We should carefully monitor patient who undergo ureteral stenting for ongoing obstruction and complication.
Female ; Follow-Up Studies ; Humans ; Hydronephrosis ; Medical Records ; Nephrostomy, Percutaneous ; Organothiophosphorus Compounds ; Pregnenolone Carbonitrile ; Referral and Consultation ; Stents ; Stomach ; Ureter ; Ureteral Obstruction

A 67-year old woman was admitted due to left femur neck fracture. Pre-operative laboratory data revealed azotemia, and kidney ultrasonogram and pelvis MRI showed bilateral hydronephrosis and huge uterine myoma. On past history, she had uterine myoma since her thirties, but she refused to undergo operation. We initially planned percutaneous nephrostomy (PCN). After stabilization of renal function, we performed subsequent total hysterectomy after insertion of catheters on both ureters, and PCN catheters were removed after confirming that both ureteral catheters worked well. During follow up period of two months after PCN, renal function was gradually improved, but it was not normalized. Size of removed myoma was about 25x15 cm, and histopathologic findings were consistent with leiomyoma. In conclusion, myoma uteri is one of the rare causes of bilateral hydronephrosis, and it may lead to irreversible damage to kidney if left untreated for a long time.
Aged ; Azotemia ; Catheters ; Female ; Femoral Neck Fractures ; Follow-Up Studies ; Humans ; Hydronephrosis* ; Hysterectomy ; Kidney ; Kidney Failure, Chronic ; Leiomyoma* ; Magnetic Resonance Imaging ; Myoma ; Nephrostomy, Percutaneous ; Pelvis ; Pregnenolone Carbonitrile ; Ultrasonography ; Ureter ; Urinary Catheters ; Uterus